Bureau Veritas - Safe OT - Concept Note

Safe OT
Protect Healthcare Personnel…

Defining Occupational Health and Safety
Workplace Health and Safety, often referred to as Occupational Health and Safety (OH&S) involves the
assessment and minimization of risks that may impact the health, safety or welfare of those in your
workplace. This may include the health and safety of your customers, employees, visitors, contractors,
volunteers and suppliers. As a business owner there are legal requirements that you must comply with to
ensure your workplace meets OHS obligations.
Images sourced from internet and used for representation purpose only.
DEFINING OCCUPATIONAL HEALTH AND SAFETY
Risk: effect of uncertainty injury and ill health: adverse effect on the
physical, mental or cognitive condition of a
Hazard: source with a potential to cause person
injury and ill health
Incident: occurrence arising out of, or in

the course of, work that could or does
result in injury and ill health occupational health and safety policy
OH&S policy: policy to prevent work-related injury and
ill health to workers and to provide safe and healthy
workplaces.
occupational health and safety risk

OH&S risk: combination of the likelihood of occurrence
of a work-related hazardous event(s) or exposure(s) and
the severity of injury and ill health that can be caused by
the event(s) or exposure(s)
occupational health and safety opportunity

OH&S opportunity: circumstance or set of circumstances that can lead
to improvement of OH&S performance
Definitions: Source ISO 45001:2018 Images sourced from internet and used for representation purpose only.
Need of OHS for Healthcare Organizations….
 The costs of occupational accidents and ill health are
prohibitive
 Increases in the numbers of successful claims for
compensation against organizations insurance premiums
 Ever stricter legislation and bigger fines
 Customer pressure and access to market place.
 Industrial relations and staff morale
 Public relations
 Moral imperative
If you think safety is too expensive….try an accident

Doctor .. Who is your Doctor?
According to estimates by the American Occupational Safety and Health Administration (OSHA), more than 200,000
health professionals are at risk of occupational diseases due to chronic exposure to WAGs.
2016 study carried out in a tertiary care hospital in New Delhi reported that over 40% of resident doctors were
exposed to violence in the workplace in the past 12 months. The Indian Medical Association (IMA) has reported that
75% of doctors have faced physical or verbal violence during their lifetime. “
Approximately 10,00,000 NSI incidents happen in Europe1 each year and about 80,000 HCW2 get infected with HIV,
HCV, HBV due to NSI incidents.
Burnout, Depression, Stress and other work related ailments on rise in healthcare workers.
Source: EPInet
(1) Himmelreich, H., et al.The Management of Needlestick Injuries. Dtsch Arztebl Int. 2013 Feb; 110(5): 61–67.
(2) Prüss-Ustün A, Rapiti E, Hutin Y. Estimation of the global burden of disease attributable to contaminated sharps injuries among health-care workers. Am J Ind Med. 2005 Dec;48(6):482-90.
Occupational Health Hazards in Healthcare Organisation
 Blood/body fluid exposures from sharps
 Exposure to released particulates
 Exposures to waste anesthetic gases
 Possible exposures to chemical cleaning agents
 Slips/trips/fall hazards
 Exposures to lasers/ X-ray, Radiations
 Hitting heads on OR lights
 Electrical shock hazards
 Fire Hazard
 Mental fatigue, ergonomics
Current Scenario of OHS in Indian Healthcare Context….
 There are various guidelines available for

assessment of Healthcare Organisations
focussing the Patient safety, service quality
etc.
 Regulation on the Violence against doctors
is established. (Prevention of Violence Against
Doctors, Medical Professionals and Medical Institutions
Act, 2018)
 Sector Specific guidelines are required in
order to address the occupational hazards
in the Healthcare Organisations.
Steps For Implementing OHS
Identify
Hazard
Source
Removal
Identify Maintain Risk
Hazard Register Training &
Communication
Prevention of OHS Risk in Healthcare Organization
Conduct written risk assessment for hazards
 Physical / Ergonomic
 Chemical
 Biological
 Psychosocial
Assess risk and estimate degree of risk at regular intervals (Annually at least)
Hazard identification methodologies vary, e.g. an organization can begin its hazard identification by simply walking
around the workplace, looking at manufacturers’ instructions and considering past accidents and incidents and by
consulting workers.
Risk Mitigation
 Elimination
 Substitution
 Engineering Control
 Personal Protective Equipment
 Organizational Control
Risk Mitigation – Examples
 Remove or isolate the hazard
 Use safety needles
 Transport blood specimens in leak- and puncture-resistant boxes
 Use puncture-resistant waste boxes for discarding sharp items and needles
 Evaluate use of personal protective equipment
 Gloves – Single use always
 Gowns – Single use preferred
 Eye goggles or face shields
 Use if spills/splashes to the face possible
 Disinfect regularly and if visibly soiled
 Masks and respirators
 N95/FFP respirators with a tight face seal used if a risk of exposure to
airborne pathogens
 When not available, use surgical masks Images sourced from internet and used for representation purpose only.
Risk Mitigation – Examples
 Organisational measures
 Limit number of staff in direct contact in case of patients with highly infectious disease.
 Competency Building by regular training on safe work practices
 Establish an occupational safety committee
 Strict adherence to SOPs
 Periodic Monitoring and Review of outcome
 Medical examination for all Healthcare Staff on periodic basis and in case of incident.
 Vaccination of Healthcare Staff
 All injuries / OHS Incidents documented in the respective staff member’s medical records.
Safe Operation
Theatre (Safe OT)
Like a well-oiled machine, hospital operating room
protocol could always use a tune-up. ORs rely on
several moving parts to conduct surgeries safely
and efficiently, and all of the moving parts have to
be alert, careful and calm.

Safe Operation Theatres
However, operating rooms can be dangerous places as
harm to both patients and operators can occur in many
different ways. Although most people understand that
patients in operating rooms undergo risky, highly complex,
and potentially life-threatening procedures, they seem
much less aware that operating rooms have many
potentially harmful energy devices used by
anesthesiologists, surgeons, and nurses.
Malfunction or misapplication of these devices can

endanger the well-being of both the patient and the
operator.
Safe OT – Protecting HCPs
Psychosocial Hazards
• Stress, Trauma, PTSD
• Burn out
• Ergonomics
• Self Medication
• Substance abuse
Organisational Control
• Leadership
• Awareness Physical Hazards
• Monitoring & measurement • Slip / Trip and Falls
• Change Management • Injury due to Sharps
• No Compromise on Safety • Electrical Shocks
• Radiation / Lasers
OT Infrastructure • Violence at work
• OT Layout & Design
• OT Equipment
• Storage Biological Hazards
• Cleaning & Hygiene • Exposure to Blood and body fluids
• Air Management • Particulate releases
• Waste Management • Infected waste from OT
Hazard & Risk Identification
• Hazard Identification Chemical Hazards
• Hazard Source Id. • Waste Anaesthetic Gases
• Hazard Removal • Cleaning chemicals
• Risk Register • Eye Irritation due Aerosols
• Training and Comm. • AllergiesImages
due sourced
to latex,
from sterilizing chems.
internet and used for representation purpose only.
Organisational Control
 Leadership Commitment
 Spreading Awareness
 Building Risk Management in all aspects of
governance.
 Competency Management
 Regular Review of the OT Safety policies and

 Internal audits, Monitoring & procedures
Measurement  Periodic audits and review of outcomes
 Communication with all stakeholders  Change management
 “No Compromise on Safety” – a loud and  Training and periodic retraining on the procedures
Clear message must be sent to all for staff involved in OT management & operations
employees.
OT Infrastructure
 OT Design & Layout  Environmental Cleaning

 Location  Twice Daily
 Outer Zone  Air Quality Monitoring
 Clean / Semi restricted Zone  Unidirectional Air Flow
 Restricted Zone  Negative Pressure in OT
 Ventilation Management
 OT Equipment  Waste Management

 Operation & Maintenance  Waste Disposal
 Decontamination / Sterilization  Linen Management
 Storage Facilities  Central Laundry
 Storage facilities for Drugs,  Hygiene Management
Chemicals  Hand Scrub
 Storage for OT Linen  Operation room clothing
 Storage for OT Instruments
Hazard and Risk identification
 Hazard / Risk identification

 Hazard source identification
 Capability assessment
 Hazard mitigation strategy
 Hazard Removal
 Risk Register
 Training and Communication
 Elimination
 Substitution
 Chemical Hazards
 Engineering Control
 Biological Hazards
 PPEs
 Physical Hazards
 Organisational Control
 Psychosocial Hazards
Chemical Hazards
 Exposure to Waste Anaesthetic Gases

 Allergies due to Soaps, disinfectants, sterilizers
 Exposure to aerosols
 Chronic poisoning because of long-term exposure to
medications, sterilizing fluids (e.g., glutaraldehyde),
anaesthetic gases, etc.
 Active scavenging system for WAGs
 Knowledge of MSDS for all chemicals used
 Use of appropriate PPEs
Biological Hazards
 Nosocomial Infections / Seeding of

microflora due to
 Exposure to Blood and Body Fluids
 Particulate Releases
 prick from a syringe needle
 Health Complications for female workers
(miscarriages etc.)
 Thorough cleaning, sanitation and
sterilization of OT equipment
 Air Changes
 Periodic surface testing for microbes
Physical Hazards
 Slip, trip and fall

 Electrical Hazards
 Fire and Water hazards
 Explosion
 Workplace violence
 Ergonomic Issues
 Sharps and Needle injuries
Psychosocial Hazards
 Fatigue due to prolonged periods of work in a

standing posture.
 Psychological stress. PTSD, Burnout
 Self Medication, Substance abuse.
 Mental impact of Violence by Patient relatives
Assessment and
Certification
Roadmap
Roadmap
Desktop Review Grading and Issuance of certificate
• Assessment using the SAQ submitted by
• Certificate awarded as per the final score and grade
Hospital team
achieved.
• Virtual Mode
 Less than 80% - Fail
• Gap identification
 80% to – 90% - Gold
• Planning for Main Assessment
 91% – 95% - Diamond
 96% - 100% - Platinum
• Certificate is valid for 3 years subject to regular
surveillance Assessments and Grade Maintained.
START
Surveillance Assessments
 Surveillance assessments carried out at 6
Self Assessment & Training Main Assessment monthly or Annual frequency.
 Self assessment using the SAQ • Full system assessment  Unannounced Surveillances
 Review of findings internally • Employee interview
 Review with BV Assessor • SOP verification
• GAP Reporting Images sourced from internet and used for representation purpose only.

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Safe OT

Protect Healthcare Personnel…

Incident: occurrence arising out of, or in

occupational health and safety risk

occupational health and safety opportunity

If you think safety is too expensive….try an accident

 There are various guidelines available for

be alert, careful and calm.

Malfunction or misapplication of these devices can

 Regular Review of the OT Safety policies and

 OT Design & Layout  Environmental Cleaning

 OT Equipment  Waste Management

 Hazard / Risk identification

 Exposure to Waste Anaesthetic Gases

 Nosocomial Infections / Seeding of

 Slip, trip and fall

 Fatigue due to prolonged periods of work in a

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